城镇职工医疗保险制度运行效果评价  

Evaluation on performance of urban employee basic medical insurance in Heilongjiang province

作　　者：潘琳 杨世雅 齐新业 郑统 邵瑛琦 张鑫 尹航 王佳慧 陈若卉 吴群红 PAN Lin;YANG Shi-ya;QI Xin-ye(Department of Social Medicine,School of Public Health,Harbin Medical University,Harbin,Heilongjiang Province 150081,China;不详)

机构地区：[1]哈尔滨医科大学公共卫生学院社会医学教研室,黑龙江哈尔滨150081 [2]北京美中宜和医疗管理有限公司

出　　处：《中国公共卫生》2021年第2期303-306,共4页Chinese Journal of Public Health

基　　金：国家自然科学基金(71333003)。

摘　　要：目的评价黑龙江省城镇职工医保制度的卫生筹资、卫生服务利用及经济保护能力的公平性,分析存在的主要问题及产生原因,为提出改进建议提供依据。方法使用负担贡献率和公平性指数、集中指数、灾难性卫生支出等指标对国家统计局等部门发布统计数据及2003、2008、2013年国家卫生服务调查中的黑龙江省数据进行城镇职工医保制度的运行效果评价。结果制度实施后,城镇职工家庭卫生筹资公平性减低,家庭卫生服务筹资公平性指数(FFC)从0.2939下降到0.2526,不同收入人群对于门诊和住院的卫生服务利用总体处于不公平状态,2013年的水平公平性指数(HI)分别为0.0240、0.0880,灾难性卫生支出的发生率上升11.84%。结论城镇职工医疗保险制度的实施在一定程度上缓解了城镇职工因病致贫现象,但筹集公平性、卫生服务利用公平性、经济保护能力仍需进一步提高,在制定相关政策时需重点考虑贫困人群,给予相应照顾。Objective To evaluate the fairness in health financing,health service utilization and economic protection capacity of urban employee basic medical insurance(UEBMI)in Heilongjiang province and to provide evidences for improving the performance of the medical insurance system.Methods We collected the data on operation effect of UEBMI in Heilongjiang province from statistics published by National Bureau of Statistics and other governmental agencies and the dataset of three waves of national health service survey conducted in 2003,2008 and 2013.We adopted burden contribution rate,fairness index,concentration index(CI),and catastrophic health expenditure(CHE)in analyses on the fairness in the operation of the health insurance system.Results In the province,the family health financing contribution index decreased from 0.2939 to 0.2526 after the implementation of UEBMI,indicating a decline in the equity of family health financing among the workers;the utilization of outpatient and hospitalization medical service were not balanced generally among workers with various income levels,with the horizontal fairness index of 0.0240 and 0.0880 for outpatient and hospitalization service utilization in 2013.The CHE increased from 9.79%in 2003 to 21.63%in 2013 among the urban workers surveyed.Conclusion The fairness in health financing,health service utilization and economic protection capacity need to be improved for the operation of urban employee basic medical insurance in Heilongjiang province.

关 键 词：城镇职工 基本医疗保险 实施效果 评价 

分 类 号：R19[医药卫生—卫生事业管理]